Maria Alexandrovna Aleshin, MD

All Publications

• Innovations in Hidradenitis Suppurativa. Dermatologic clinics Park, S. E., Hsiao, J. L., Aleshin, M. A. 2025; 43 (1): 35-53

  Abstract

  Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by painful, recurrent abscesses, inflammatory nodules, and draining tunnels. Biologic and small molecule therapeutics are effective for treatment of moderate-to-severe HS. The field of HS is rapidly growing with numerous ongoing clinical trials exploring novel agents. This review highlights the latest discoveries in the field of HS, with a particular focus on novel therapeutic agents and procedural management.

  View details for DOI 10.1016/j.det.2024.08.003

  View details for PubMedID 39542563

• Antibiotic, hormonal/metabolic, and retinoid therapies for hidradenitis suppurativa. Journal of the American Academy of Dermatology Fonjungo, F. E., Barnes, L. A., Aleshin, M. A. 2024; 91 (6S): S37-S41

  Abstract

  Hidradenitis suppurativa (HS), a chronic painful inflammatory skin condition, remains a persistent challenge in dermatology. Its complex pathogenesis has yet to be fully understood, complicating the identification of effective therapeutic strategies.This study aims to investigate the latest insights on antibiotics, hormonal/metabolic interventions, and oral retinoids in the management of HS.A narrative review was conducted to gather data on the efficacy and safety of oral antibiotics, hormonal interventions, and oral retinoids in HS from relevant studies and clinical trials.Oral antibiotics, such as tetracyclines and clindamycin-rifampin combination therapy, demonstrated significant improvements in disease severity scores. Hormonal interventions, targeting androgen receptors and insulin resistance, showed promising results in symptom management and improving disease severity. Oral retinoids, including isotretinoin and acitretin, displayed variable efficacy, with acitretin demonstrating more pronounced improvements.The variability in study designs, patient populations, and duration of follow-up across the reviewed literature may affect the generalizability of these findings.While antibiotics continue to play a foundational role, hormonal/metabolic therapies and oral retinoids offer additional avenues for alleviating HS symptoms and addressing its intricate pathogenesis. These findings underscore the importance of personalized treatment approaches tailored to individual patient needs.

  View details for DOI 10.1016/j.jaad.2024.09.015

  View details for PubMedID 39626998

• Diagnostic stewardship and dermatology consultation in cellulitis management: a systematic literature review and meta-analysis. Archives of dermatological research Lin, V., Callado, G. Y., Pardo, I., Gutfreund, M., Hsieh, M. K., Pereira, A. M., Kwong, B. Y., Aleshin, M., Holubar, M., Salinas, J. L., Diekema, D. J., Marra, A. R. 2024; 317 (1): 61

  Abstract

  Cellulitis is a common skin infection often requiring antibiotic treatment. However, misdiagnosis and inappropriate antibiotic use contribute to antibiotic resistance and healthcare costs. We aimed to evaluate the impact of dermatology consultation on treatment modification in patients with suspected cellulitis and to determine whether dermatologists' evaluation can be used as a reference to diagnose suspected cellulitis. We explored MedLine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane CENTRAL, Web of Science, and Scopus and Embase, including publications from database inception to July 25, 2023. Studies were included if they evaluated treatment modifications involving the use of antibiotics for patients with suspected cellulitis with and without dermatology consultation. We excluded comments or reviews, pilot studies, and studies without a non-dermatology control group, treatment modifications, the use of antibiotics, or patients with cellulitis. Of the 49 full-text articles, 14 studies met the selection criteria.This systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Of five independent reviewers (GYC, IP, MG, MKH, and AMRP), two abstracted data for each article using a standardized abstraction form. We used the Downs and Black scale to evaluate study quality. Subgroup analysis was conducted regarding readmission rate within 30 days for two independent populations seen by a non-dermatologist physician or a dermatologist. We employed random-effects models to obtain pooled mean differences. Heterogeneity was assessed using the I-squared value. The impact of dermatology consultation on treatment modification involving antibiotics in patients with suspected cellulitis and readmission rates in 30 days. Dermatology consultation changed initial treatment plans involving antibiotics from 47 to 96% of the time, improving diagnostic accuracy and, consequently, antibiotic stewardship of cellulitis. Dermatology consultation was not significantly associated with lower readmission rates in 30 days (pooled OR = 0.56, 95% CI: 0.25 to 1.25, I2 = 0%). Dermatology consultation in patients with suspected cellulitis may improve diagnosis and management, thereby reducing antibiotic misuse, unnecessary tests, and prolonged hospitalizations.

  View details for DOI 10.1007/s00403-024-03515-x

  View details for PubMedID 39614879

  View details for PubMedCentralID 2714672

• In-office Procedures for Dermatologists Managing Hidradenitis Suppurativa CURRENT DERMATOLOGY REPORTS Gomez, J., Fonjungo, F., Chen, S. X., Aleshin, M. A., Naik, H. B., Wadhera, A., Sayed, C. J., Barnes, L. A. 2024

  View details for DOI 10.1007/s13671-024-00447-7

  View details for Web of Science ID 001311976700001

• Management of Hidradenitis Suppurativa during Pregnancy and Lactation CURRENT DERMATOLOGY REPORTS Park, S. E., Hsiao, J. L., Aleshin, M. A. 2024

  View details for DOI 10.1007/s13671-024-00443-x

  View details for Web of Science ID 001296479700001

• Analysing common topics of secure patient messages in hidradenitis suppurativa: a text-embedding and natural language-processing approach. The British journal of dermatology Chen, M. L., Kim, J., Naik, H. B., Aleshin, M. A., Sarin, K. Y., Barnes, L. A., Linos, E. 2024

  View details for DOI 10.1093/bjd/ljae222

  View details for PubMedID 38975641

• Expert Practices in Hidradenitis Suppurativa Flare Management: A Cross-Sectional Survey Study. Skin appendage disorders Masson, R., Park, S., Shi, V. Y., Hsiao, J. L., Aleshin, M. A. 2024; 10 (3): 224-228

  Abstract

  Hidradenitis suppurativa (HS) is a chronic skin condition with recurrent, debilitating flares. Although the majority of patients with HS endorse flares, there is a lack of research regarding HS experts' flare management practices and perspectives.An anonymous online survey was distributed through an HS expert listserv. Board-certified dermatologists who saw 1 or more HS patient(s) per month were eligible for participation.A total of 35 responses were collected; 97.1% self-identified as HS experts. Therapies used for HS flares by more than two-thirds of the respondents included systemic antibiotics (100%), nonprescription pain relievers (91.4%), intralesional triamcinolone injections (91.4%), prescription pain relievers (71.4%), oral corticosteroids (68.6%), and warm compresses (68.6%). The top 3 dermatologist-reported barriers that patients face in accessing care during flares include lack of clinic appointment availability (88.6%), distance that patients have to travel to reach clinic (85.7%), and lack of transportation for patients (62.9%).Overall, this study highlights variations in the ways that HS experts manage flares. Many of the treatment modalities used by the majority of respondents are not part of the official North American guidelines. Further prospective studies and expert consensus guidelines are needed to standardize the approach to flare management.

  View details for DOI 10.1159/000536094

  View details for PubMedID 38835706

  View details for PubMedCentralID PMC11147513

• Expert Practices in Hidradenitis Suppurativa Flare Management: A Cross-Sectional Survey Study SKIN APPENDAGE DISORDERS Masson, R., Park, S., Shi, V. Y., Hsiao, J. L., Aleshin, M. A. 2024

  View details for DOI 10.1159/000536094

  View details for Web of Science ID 001171065500001

• Patient practices in hidradenitis suppurativa flare management: a cross-sectional survey study. Archives of dermatological research Park, S. E., Masson, R., Shih, T., Shi, V. Y., Hsiao, J. L., Aleshin, M. A. 2023; 316 (1): 13

  View details for DOI 10.1007/s00403-023-02782-4

  View details for PubMedID 38047926

  View details for PubMedCentralID 9633352

• Longitudinal remote monitoring of hidradenitis suppurativa: a pilot study. The British journal of dermatology Fonjungo, F. E., Barnes, L. A., Cai, Z. R., Naik, H. B., Eid, E. S., Aleshin, M. A., Nava, V., Johnson, T., Chren, M., Linos, E. 2023

  View details for DOI 10.1093/bjd/ljad385

  View details for PubMedID 37823362

• Hidradenitis suppurativa and Ehlers-Danlos syndrome: A case-control study. JAAD international Hua, V. J., Li, S., Sarin, K. Y., Aleshin, M. 2023; 12: 70-71

  View details for DOI 10.1016/j.jdin.2023.03.008

  View details for PubMedID 37274386

  View details for PubMedCentralID PMC10236182

• A practical guide to starting a hidradenitis suppurativa specialty clinic. JAAD international Shih, T., Lee, K., Aleshin, M., Bennett, R., Mayo, T., Okoye, G. A., Villa, N., Sayed, C. J., Shi, V. Y., Hsiao, J. L. 2023; 11: 117-120

  View details for DOI 10.1016/j.jdin.2023.01.021

  View details for PubMedID 36950265

• Evolution of a Project to Improve Inpatient-to-Outpatient Dermatology Care Transitions: Mixed Methods Evaluation. JMIR dermatology Kling, S. M., Aleshin, M. A., Saliba-Gustafsson, E. A., Garvert, D. W., Brown-Johnson, C. G., Amano, A., Kwong, B. Y., Calugar, A., Shaw, J. G., Ko, J. M., Winget, M. 2023; 6: e43389

  Abstract

  BACKGROUND: In-hospital dermatological care has shifted from dedicated dermatology wards to consultation services, and some consulted patients may require postdischarge follow-up in outpatient dermatology. Safe and timely care transitions from inpatient-to-outpatient specialty care are critical for patient health, but communication around these transitions can be disjointed, and workflows can be complex.OBJECTIVE: In this 3-phase quality improvement effort, we developed and evaluated an intervention that leveraged an electronic health record (EHR) feature, known as SmartPhrase, to enable a new workflow to improve transitions from inpatient care to outpatient dermatology.METHODS: Phase 1 (February-March 2021) included interviews with patients and process mapping with key stakeholders to identify gaps and inform an intervention: a SmartPhrase table and associated workflow to promote collection of patient information needed for scheduling follow-up and closed-loop communication between dermatology and scheduling teams. In phase 2 (April-May 2021), semistructured interviews-with dermatologists (n=5), dermatology residents (n=5), and schedulers (n=6)-identified pain points and refinements. In phase 3, the intervention was evaluated by triangulating data from these interviews with measured changes in scheduling efficiency, visit completion, and messaging volume preimplementation (January-February 2021) and postimplementation (April-May 2021).RESULTS: Preintervention pain points included unclear workflow for care transitions, limited patient input in follow-up planning, multiple messaging channels (eg, EHR based, email, and phone messages), and time-inefficient patient tracking. The intervention addressed most pain points; interviewees reported the intervention was easy to adopt and improved scheduling efficiency, workload, and patient involvement. More visits were completed within the desired timeframe of 14 days after discharge during the postimplementation period (21/47, 45%) than the preimplementation period (28/41, 68%; P=.03). The messaging workload also decreased from 88 scheduling-related messages sent for 25 patients before implementation to 30 messages for 8 patients after implementation.CONCLUSIONS: Inpatient-to-outpatient specialty care transitions are complex and involve multiple stakeholders, thus requiring multifaceted solutions. With deliberate evaluation, broad stakeholder input, and iteration, we designed and implemented a successful solution using a standard EHR feature, SmartPhrase, integrated into a standardized workflow to improve the timeliness of posthospital specialty care and reduce workload.

  View details for DOI 10.2196/43389

  View details for PubMedID 37632927

• Erythema Gyratum Repens Secondary to Pulmonary Tuberculosis. Annals of internal medicine Contag, C. A., Maloney, N., Tayyar, R., Aleshin, M. A., Novoa, R. A., Ho, D. Y. 2023

  View details for DOI 10.7326/L22-0453

  View details for PubMedID 36913686

• Addition of intravenous immunoglobulin therapy to facilitate resolution of steroid-refractory DRESS syndrome Kumar, A. M., Besen, J., Aleshin, M. MOSBY-ELSEVIER. 2022: AB13

  View details for Web of Science ID 000891793200049

• Teledermatology to Facilitate Patient Care Transitions From Inpatient to Outpatient Dermatology: Mixed Methods Evaluation. Journal of medical Internet research Kling, S. M., Saliba-Gustafsson, E. A., Winget, M., Aleshin, M. A., Garvert, D. W., Amano, A., Brown-Johnson, C. G., Kwong, B. Y., Calugar, A., El-Banna, G., Shaw, J. G., Asch, S. M., Ko, J. M. 2022; 24 (8): e38792

  Abstract

  BACKGROUND: Both clinicians and patients have increasingly turned to telemedicine to improve care access, even in physical examination-dependent specialties such as dermatology. However, little is known about whether teledermatology supports effective and timely transitions from inpatient to outpatient care, which is a common care coordination gap.OBJECTIVE: Using mixed methods, this study sought to retrospectively evaluate how teledermatology affected clinic capacity, scheduling efficiency, and timeliness of follow-up care for patients transitioning from inpatient to outpatient dermatology care.METHODS: Patient-level encounter scheduling data were used to compare the number and proportion of patients who were scheduled and received in-clinic or video dermatology follow-ups within 14 and 90 days after discharge across 3 phases: June to September 2019 (before teledermatology), June to September 2020 (early teledermatology), and February to May 2021 (sustained teledermatology). The time from discharge to scheduling and completion of patient follow-up visits for each care modality was also compared. Dermatology clinicians and schedulers were also interviewed between April and May 2021 to assess their perceptions of teledermatology for postdischarge patients.RESULTS: More patients completed follow-up within 90 days after discharge during early (n=101) and sustained (n=100) teledermatology use than at baseline (n=74). Thus, the clinic's capacity to provide follow-up to patients transitioning from inpatient increased from baseline by 36% in the early (101 from 74) and sustained (100 from 74) teledermatology periods. During early teledermatology use, 61.4% (62/101) of the follow-ups were conducted via video. This decreased significantly to 47% (47/100) in the following year, when COVID-19-related restrictions started to lift (P=.04), indicating more targeted but still substantial use. The proportion of patients who were followed up within the recommended 14 days after discharge did not differ significantly between video and in-clinic visits during the early (33/62, 53% vs 15/39, 38%; P=.15) or sustained (26/53, 60% vs 28/47, 49%; P=.29) teledermatology periods. Interviewees agreed that teledermatology would continue to be offered. Most considered postdischarge follow-up patients to be ideal candidates for teledermatology as they had undergone a recent in-person assessment and might have difficulty attending in-clinic visits because of competing health priorities. Some reported patients needing technological support. Ultimately, most agreed that the choice of follow-up care modality should be the patient's own.CONCLUSIONS: Teledermatology could be an important tool for maintaining accessible, flexible, and convenient care for recently discharged patients needing follow-up care. Teledermatology increased clinic capacity, even during the pandemic, although the timeliness of care transitions did not improve. Ultimately, the care modality should be determined through communication with patients to incorporate their and their caregivers' preferences.

  View details for DOI 10.2196/38792

  View details for PubMedID 35921146

• Acanthosis nigricans in the setting of severe pulmonary disease exacerbated by COVID-19 infection. JAAD case reports Hirotsu, K. E., Chiang, A., Bahrani, E., Cloutier, J. M., Rieger, K. E., Kwong, B. Y., Aleshin, M. 2022

  View details for DOI 10.1016/j.jdcr.2022.04.017

  View details for PubMedID 35529073

• Hidradenitis Suppurativa in Sexual and Gender Minorities: A Review and Considerations for Providers. Journal of the American Academy of Dermatology Gomez, J., Barnes, L. A., Yost, J. M., Gordon, J., Ginsberg, B. A., Aleshin, M. 2022

  Abstract

  The literature on hidradenitis suppurativa (HS) in sexual and gender minorities (SGM) remains sparse. This review article aims to discuss critical factors for providers to consider in LGBTQIA patients with HS, including associated comorbidities, gender-affirming hormonal therapy, squamous cell carcinoma, infections in HIV-positive patients, and creating a welcoming clinic for SGM patients.

  View details for DOI 10.1016/j.jaad.2022.03.008

  View details for PubMedID 35283243

• Pyoderma Gangrenosum After Bilateral Total Knee Arthroplasty. Arthroplasty today Loomis, R., Merrit, M., Aleshin, M. A., Graw, G., Lee, G., Graw, B. 2021; 11: 73-79

  Abstract

  Pyoderma gangrenosum is a neutrophilic dermatosis, which mimics both infection and necrotizing fasciitis, that can present after surgical interventions. We present the case of a 62-year-old male who underwent one-stage bilateral total knee arthroplasty. Nine days after the surgery, he presented with wound breakdown, high fever, and elevated white blood cell count. Repeated debridement was performed, and empiric antibiotics were given. All tissue cultures and aspirates remained negative throughout treatment course, and the patient remained unresponsive to therapy. The patient was eventually diagnosed with pyoderma gangrenosum after infectious etiologies were ruled out and after a skin biopsy and dermatologic consultation. His condition rapidly improved after treatment with corticosteroids, and soft-tissue defects were repaired with skin substitute and full-thickness skin grafting. In patients with aseptic wound breakdown after total knee arthroplasty, pyoderma gangrenosum is a rare but devastating complication and should be considered.

  View details for DOI 10.1016/j.artd.2021.07.003

  View details for PubMedID 34485653

• Hemophagocytic lymphohistiocytosis secondary to progressive disseminated histoplasmosis presenting as cellulitis. Medical mycology case reports Puing, A. G., Raghavan, S. S., Aleshin, M. A., Ho, D. Y. 2021; 33: 18-20

  Abstract

  Histoplasmosis-associated hemophagocytic lymphohistiocytosis is a rate but lethal disease in immunocompromised hosts. Unusual clinical presentations make diagnosing invasive fungal infection even more challenging. Here we present a case of hemophagocytic lymphohistiocytosis secondary to progressive disseminated histoplasmosis presenting as cellulitis in a patient with systemic lupus erythematous. A high index of suspicion combined with histopathology and molecular diagnostic techniques are important to establish an accurate and timely diagnosis of opportunistic infections in immunocompromised patients.

  View details for DOI 10.1016/j.mmcr.2021.06.002

  View details for PubMedID 34307009

• Histopathologic correlation of skin manifestations of multisystemic inflammatory syndrome in adults (MIS-A) associated with SARS-CoV-2 infection. JAAD case reports So, N. A., So, J., Centkowski, S., Rana, J., Aleshin, M., Kwong, B. Y., Rieger, K., Zaba, L. C., Chiou, A. S. 2021

  View details for DOI 10.1016/j.jdcr.2021.06.031

  View details for PubMedID 34405113

• Phenotypic characteristics of T cells co-expressing SOX2, OCT3/4, and NANOG Cerniglia, M., Escuin-Ordinas, H., Porter, C., Aleshin, M., Cheung-Lau, G., Galic, Z., Abraham-Davidi, I., Shin, D., Rosenblatt-Rosen, O., Ribas, A., Comin-Anduix, B. AMER ASSOC CANCER RESEARCH. 2021

  View details for Web of Science ID 000680263502190

• Efficacy of Etanercept in the Treatment of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Cutis Dreyer, S. D., Torres, J., Stoddard, M., Leavitt, E., Sutton, A., Aleshin, M., Crew, A., Worswick, S. 2021; 107 (6): E22-E28

  Abstract

  It has been suggested that the use of etanercept for treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) might provide improved mortality benefit and decreased skin healing times. This retrospective study compared the use of single-dose subcutaneous etanercept to intravenous immunoglobulin (IVIG) and supportive care alone. Thirteen patients were treated with a single dose (50 mg) of subcutaneous etanercept. Results of this study support the use of etanercept as a potentially beneficial agent in the treatment of SJS/TEN.

  View details for DOI 10.12788/cutis.0288

  View details for PubMedID 34314327

• Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multicenter Retrospective Study of 377 Adult Patients from the United States (vol 138, pg 2315, 2018) JOURNAL OF INVESTIGATIVE DERMATOLOGY Micheletti, R. G., Chiesa-Fuxench, Z., Noe, M. H., Stephen, S., Aleshin, M., Agarwal, A., Boggs, J., Cardones, A. R., Chen, J. K., Cotliar, J., Davis, M. P., Dominguez, A., Fox, L. P., Gordon, S., Hamrick, R., Ho, B., Hughey, L. C., Jones, L. M., Kaffenberger, B. H., Kindley, K., Kroshinsky, D., Kwong, B. Y., Miller, D. D., Mostaghimi, A., Musiek, A., Ortega-Loayza, A. G., Patel, R., Posligua, A., Rani, M., Saluja, S., Sharon, V. R., Shinkai, K., St John, J., Strickland, N., Summers, E. M., Sun, N., Wanat, K. A., Wetter, D. A., Worswick, S., Yang, C., Margolis, D. J., Gelfand, J. M., Rosenbach, M. 2019; 139 (2): 495–96

  View details for DOI 10.1016/j.jid.2018.11.013

  View details for Web of Science ID 000456162000049

• Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multicenter Retrospective Study of 377 Adult Patients from the United States JOURNAL OF INVESTIGATIVE DERMATOLOGY Micheletti, R. G., Chiesa-Fuxench, Z., Noe, M. H., Stephen, S., Aleshin, M., Agarwal, A., Boggs, J., Cardones, A. R., Chen, J. K., Cotliar, J., Davis, M. P., Dominguez, A., Fox, L. P., Gordon, S., Hamrick, R., Ho, B., Hughey, L. C., Jones, L. M., Kaffenberger, B. H., Kindley, K., Kroshinsky, D., Kwong, B. Y., Miller, D. D., Mostaghimi, A., Musiek, A., Ortega-Loayza, A. G., Patel, R., Posligua, A., Rani, M., Saluja, S., Sharon, V. R., Shinkai, K., St John, J., Strickland, N., Sun, N., Wanat, K. A., Wetter, D. A., Worswick, S., Yang, C., Margolis, D. J., Gelfand, J. M., Rosenbach, M. 2018; 138 (11): 2315–21

  Abstract

  Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, severe mucocutaneous reaction with few large cohorts reported. This multicenter retrospective study included patients with SJS/TEN seen by inpatient consultative dermatologists at 18 academic medical centers in the United States. A total of 377 adult patients with SJS/TEN between January 1, 2000 and June 1, 2015 were entered, including 260 of 377 (69%) from 2010 onward. The most frequent cause of SJS/TEN was medication reaction in 338 of 377 (89.7%), most often to trimethoprim/sulfamethoxazole (89/338; 26.3%). Most patients were managed in an intensive care (100/368; 27.2%) or burn unit (151/368; 41.0%). Most received pharmacologic therapy (266/376; 70.7%) versus supportive care alone (110/376; 29.3%)-typically corticosteroids (113/266; 42.5%), intravenous immunoglobulin (94/266; 35.3%), or both therapies (54/266; 20.3%). Based on day 1 SCORTEN predicted mortality, approximately 78 in-hospital deaths were expected (77.7/368; 21%), but the observed mortality of 54 patients (54/368; 14.7%) was significantly lower (standardized mortality ratio = 0.70; 95% confidence interval = 0.58-0.79). Stratified by therapy received, the standardized mortality ratio was lowest among those receiving both steroids and intravenous immunoglobulin (standardized mortality ratio = 0.52; 95% confidence interval 0.21-0.79). This large cohort provides contemporary information regarding US patients with SJS/TEN. Mortality, although substantial, was significantly lower than predicted. Although the precise role of pharmacotherapy remains unclear, co-administration of corticosteroids and intravenous immunoglobulin, among other therapies, may warrant further study.

  View details for PubMedID 29758282